Study Procedures: Blood samples (10 cc) will be drawn immediately (within 24 hours) prior to access surgery, and 1 week, and 1, 3, 6 and 12 months, and upon dialysis initiation.(6 samples per subject over 1 year) Once the patient is on hemodialysis the blood samples will be drawn pre-HD via the access. Samples will be centrifuged immediately (3000 rpm x 10 minutes), cooled within 1 hour, and stored at -80 degrees C. Pre-dialysis samples will be tested for high-sensitivity C-Reactive Protein (hsCRP) TNF-α and IL-6 (both ELISA assay, plasma by sandwich-type immunoassay) levels. Patient demographic and other clinical data will be recorded, This includes age, race, sex, body surface area, DM, SLE and other connective tissue diseases, malignancy, history of atherosclerotic diseases (CAD, PVD, CVA), active infection, history of viral infection with hepatitis B or C, human immunodeficiency virus. Routine monthly lab results drawn pre-dialysis as part of clinical practice will be recorded, these include serum albumin, complete blood count, electrolytes, blood urea nitrogen, creatinine, liver function tests, and lipid profile. Medications will be reviewed for the presence of ACE-Inhibitors, ARBs, aspirin, NSAIDS, statins. A subjective global assessment score (SGA) and comorbidity risk score will be performed. (17,18) Date of HD initiation, and type of HD membrane will be recorded. Clinical events after vascular access surgery will be monitored, including infection, hospitalization (reason), MI, CVA. Outcomes to be recorded will include access survival (primary and secondary patency), patient mortality (all-cause, infectious and cardiovascular).